Legg-Calve-Perthes Disease
(LCPD; Osteonecrosis of the Hip; Avascular Necrosis; Ischemic Necrosis; Coxa Plana; Osteochondritis)
by Patricia Griffin Kellicker, BSN
Definition
Legg-Calve-Perthes disease (LCPD) is a rare hip disease. It affects children 2-12 years old. LCPD is a disorder of the top of the leg bone. The disorder interrupts blood flow to the hip. The loss of flow impairs bone growth and causes deformity. Over time, the bone breaks and reforms causing the child to limp. LCPD most often occurs in just one hip, with only about 10% of cases involving both sides.
Hip Joint
Damage and repairs to the femoral head causes a limp.
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Causes
The cause of LCPD is unknown. Infection, trauma, and inflammatory processes are possible causes.
Risk Factors
Factors that may increase your child’s chance of developing LCPD include:
- Small or short for age
- Delayed bone age
- Athletic, active child
- Race: Asian, White, Eskimo
- Secondhand smoke exposure
- Sex: Male
- Age: 4-8 years
- Blood clotting abnormalities
Symptoms
The primary symptom of LCPD is a limp when walking. This can occur in children 2-12 years old. It peaks in children 4-8 years old. Other symptoms may include:
- Hip pain
- Groin, thigh, or knee pain
- Reduced range of motion in the hip
- Shortening of the leg, or legs that are not the same length
- Muscle weakness in the upper thigh
Diagnosis
Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. During the exam, your child’s hip will be examined to see how far it can move. The doctor may refer your child to a specialist. An orthopedist focuses on bones and joints.
Images may need to be taken of your child's bones. This can be done with:
Treatment
Talk with your doctor about the best plan for you. Options include the following:
Physical Therapy
If your child’s symptoms are mild, your doctor may prescribe physical therapy. A therapist will work with your child to maintain range of motion. You may be taught certain exercises to do with your child at home.
Medical Treatment
Medical treatment is used to prevent further injury to the hip. It may include using crutches, traction, a brace, or cast.
Surgery
In some cases, your child may need surgery. Bone removal may be done to reposition or reshape the hip bone.
RESOURCES:
American Academy
of Family Physicians
http://familydoctor.org
National Osteonecrosis Foundation
http://www.nonf.org
CANADIAN RESOURCES:
Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org
REFERENCES:
Adkins S, Figler R. Hip pain in athletes. Am Fam Physician. 2000 Apr 1;61(7):2109-2118. Available at: http://www.aafp.org/afp/20000401/2109.html . Accessed May 7, 2013.
Kleigman, Behrman, Jenson, Stanton, Eds. Nelson Textbook of Pediatrics .18th Edition. Saunders Elsevier, Philadelphia PA, 2007.
Legg-Perthes disease. National Osteonecrosis Foundation website. Available at: http://www.nonf.org/perthesbrochure/perthes-brochure.htm . Accessed May 7, 2013.
Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician. 2000 Feb 15;61(4):1011-1018. Available at: http://www.aafp.org/afp/2000/0215/p1011.html . Accessed May 7, 2013.
Last reviewed May 2013 by Kari Kassir, MD; Michael Woods, MD
Last Updated: 5/7/2013